1. A client’s electrocardiogram (ECG) is showing ST elevation in leads V2, V3, and V4.

Which artery is
most likely to be occluded?

1. Circumflex artery

2. Internal mammary artery

3. Left anterior descending artery

4. Right coronary artery

2. A nurse on a telemetry unit teaches a client diagnosed with acute coronary

syndrome about coronary blood flow. Which of the following statements made

by the nurse is correct?

1. Most of the blood flow to coronary arteries is supplied during inspiration.

2. Most of the blood flow to coronary arteries is supplied during diastole.

3. Blood flow to coronary arteries is related to breathing patterns.

4. A large portion of blood flow occurs to coronary arteries during systole.

3. Which of the following illnesses, if stated by a client, would indicate that

he understands the leading cause of death in the United States?

1. Cancer

2. Coronary artery disease (CAD)

3. Liver failure

4. Renal failure

4. A client is admitted to the telemetry floor with acute chest pain radiating

down his left arm. The nurse anticipates that which of the following laboratory

studies would be ordered to evaluate myocardial damage? Select all that

apply.
1. Hemoglobin and hematocrit

2. Serum glucose

3. Creatinine phosphokinase (CPK)

4. Troponin T and troponin I

5. Myoglobin

6. Blood urea nitrogen (BUN)

5. A nurse is teaching a client about atherosclerosis. The nurse determines

further teaching is necessary when the client makes which of the following

statements?

1. Plaques obstruct the coronary artery.

2. Plaques obstruct the vein.

3. Hardened vessels can’t dilate to allow blood to flow through.

4. Atherosclerosis can cause angina.

6. The nurse is assessing a client with angina pectoris. Which of the following

are characteristics of the substernal chest pain that occurs with this condition?

Select all that apply.

1. Occurs without cause

2. Radiates to the left arm

3. Lasts less than 15 minutes

4. Usually occurs in the morning

5. Is relieved by rest and nitroglycerine

6. Is precipitated by exertion or stress

7. The nurse is reviewing a client’s lab work to determine if a risk for

coronary artery disease (CAD) is present. The nurse is most concerned when

the results identify which of the following?

1. HDL= 100 mg/dl

2. LDL= 140 mg/dl

3. VLDL= 20%

4. Total cholesterol = 240 mg/dl

8. A client is experiencing signs and symptoms of coronary artery disease.

What should be the nurse’s first priority?

1. Decrease anxiety.

2. Enhance myocardial oxygenation.

3. Administer sublingual nitroglycerin.

4. Educate the client about his symptoms.

9. Medical management of coronary artery disease (CAD) has been discussed

with a client. The nurse anticipates that management will include which of the

following?

1. Cardiac catheterization

2. Coronary artery bypasses surgery

3. Oral medication administration

4. Percutaneous transluminal coronary angioplasty

10. A client’s electrocardiogram shows ST elevation in leads II, III, and aVF
,

suggesting occlusion of the right coronary artery. The client asks the nurse what

area of the heart this has affected. What is the nurse’s best response?

1. Anterior

2. Apical

3. Inferior

4. Lateral

11. A client with no history of cardiovascular disease comes to the ambulatory

clinic with flu-like symptoms. The client suddenly complains of chest pain.

What is the most important question for the nurse to ask the client?

1. “Can you describe the pain to me?”

2. “Have you ever had this pain before?”

3. “Does the pain get worse when you breathe in?”

4. “Can you rate the pain on a scale of 1 to 10, with 10 being the worst?”

12. Prior to administration of Lanoxin (digoxin), the nurse must obtain the

apical pulse. Where does the nurse place the stethoscope?

1. Left fifth intercostal space, midaxillary line

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2. Left fifth intercostal space, midclavicular line

3. Left second intercostal space, midclavicular line

4. Left seventh intercostal space, midclavicular line

13. A client describes knifelike chest pain that increases in intensity with
inspiration to the nurse. The nurse is aware that the most likely origin of pain

is:

1. cardiac.

2. gastrointestinal.

3. musculoskeletal.

4. pulmonary.

14. While assessing a client’s heart sounds, the nurse auscultates a murmur at

the second left intercostal space along the left sternal border. Which valve is

most likely involved?

1. Aortic

2. Mitral

3. Pulmonic

4. Tricuspid

15. The nurse is caring for a client receiving digoxin (Lanoxin). Which of the

following manifestations correlate with a digoxin level of 2.3 ng/dl? Select all

that apply.

1. Nausea

2. Drowsiness

3. Photophobia

4. Increased appetite

5. Increased energy level

6. Seeing halos around bright objects

16. A client with a myocardial infarction asks the nurse why he is receiving

morphine. What is the best response by the nurse?

1. To sedate the client

2. To decrease the client’s pain

3. To decrease the client’s anxiety

4. To decrease oxygen demand on the client’s heart

17. In caring for a client with cardiac problems, the nurse must know that the

condition most likely responsible for myocardial infarction (MI) is which of

the following?

1. Aneurysm

2. Heart failure

3. Coronary artery thrombosis

4. Renal failure

18. The nurse is aware that the supplemental medication most frequently

ordered in conjunction with furosemide (Lasix) is:

1. chloride.

2. digoxin.

3. potassium.

4. sodium.

19. In order to anticipate problems in a client following a myocardial

infarction (MI), the nurse should understand that which type of physiological

changes will increase serum glucose levels and free fatty acid production?
1. Electrophysiological

2. Hematological

3. Mechanical

4. Metabolic

20. The nurse auscultates a third heart sound (S3) while assessing her client.

The nurse is aware that this results from:

1. ventricular dilation.

2. systemic hypertension.

3. aortic valve malfunction.

4. increased atrial contractions.

21. After an anterior-wall myocardial infarction (MI), which problem is

indicated by auscultation of crackles in the lungs?

1. Left-sided heart failure

2. Pulmonic valve malfunction

3. Right-sided heart failure

4. Tricuspid valve malfunction

22. A client who is being evaluated for myocardial infarction (MI) asks the

nurse which diagnostic tool is most commonly used to determine the location

of myocardial damage. The best response by the nurse is:

1. cardiac catheterization.

2. cardiac enzymes.

3. echocardiogram.
4. electrocardiogram (ECG).

23. What is the first intervention for the nurse to implement for a client

experiencing myocardial infarction (MI)?

1. Administer morphine.

2. Administer oxygen.

3. Administer sublingual nitroglycerin.

4. Obtain an electrocardiogram (ECG).

24. A client who experienced a myocardial infarction (MI) tells the nurse he is

fearful of dying. The most appropriate response by the nurse is:

1. “Tell me about your feelings right now.”

2. “When the doctor arrives, everything will be fine.”

3. “This is a bad situation, but you’ll feel better soon.”

4. “Please be assured we’re doing everything we can to make you feel

better.”

25. What is the class of medications that protects the ischemic myocardium by

blocking catecholamines and sympathetic nerve stimulation?

1. Beta-adrenergic blockers

2. Calcium channel blockers

3. Opioids

4. Nitrates
26. The nurse is aware that a client who has just experienced a myocardial

infarction (MI) is most at risk for developing:

1. cardiogenic shock.

2. heart failure.

3. arrhythmias.

4. pericarditis.

27. A hospitalized client with heart failure suddenly develops dyspnea at rest,

disorientation, confusion, and crackles in the lung bases on auscultation. The

most important intervention(s) by the nurse would be? Select all that apply.

1. Insert a Foley catheter.

2. Monitor urinary output.

3. Administer nasal oxygen.

4. Administer a rapid-acting diuretic.

5. Place the client in a modified Trendelenburg position.

6. Administer a 500-ml intravenous (I.V.) normal saline solution bolus.

28. The nurse is preparing to assess a client for jugular vein distention. How

should the nurse position the head of the client’s bed?

1. High Fowler’s

2. Raised 10 degrees

3. Raised 30 degrees

4. Supine
29. A client is ordered to start receiving digoxin 0.25 mg P.O. What is the

priority assessment by the nurse administering the medication?

1. Apical pulse

2. Blood pressure

3. Radial pulse

4. Respiratory rate

30. The nurse is performing an admission assessment on a client who has been

diagnosed with a cardiovascular disease. The nurse would anticipate the data

to include which of the following? Select all that apply.

1. Fatigue

2. Chest pain

3. Weight loss

4. Light-headedness

5. Dependent edema

6. Difficulty breathing in an upright position

31. A nurse is monitoring a client for manifestations of cardiac tamponade. It

is important for the nurse to assess the client for which of the following? Select

all that apply.

1. Bradycardia

2. Hypertension

3. Kussmaul’s sign

4. Muffled heart sounds

5. Widened pulse pressure

6. Distended neck veins on inspiration

32. A nurse is assessing a bedridden client and notes sacral edema. The nurse

determines that the edema is most likely the result of which of the following?

1. Diabetes mellitus

2. Pulmonary emboli

3. Chronic kidney disease

4. Right-sided heart failure

33. The nurse anticipates that a client with right-sided heart failure will

exhibit which of the following?

1. Adequate urine output

2. Polyuria

3. Oliguria

4. Polydipsia

34. Which of the following drug classes should be administered to a client

with heart failure to maximize cardiac performance?

1. Beta-adrenergic blockers

2. Calcium channel blockers

3. Diuretics

4. Inotropic agents

35. The heart rhythm of a client who has experienced cardiac arrest and is
receiving cardiopulmonary resuscitation (CPR) deteriorates to ventricular

fibrillation. What is the most important action of the nurse?

1. Administer 1 mg of epinephrine I.V.

2. Defibrillate with 360 joules.

3. Continue CPR.

4. Administer vasopressin 40 units I.V.

36. Which condition is most closely associated with weight gain, nausea, and

a decrease in urine output?

1. Angina pectoris

2. Cardiomyopathy

3. Left-sided heart failure

4. Right-sided heart failure

37. A client’s rhythm strip shows a regular rhythm with atrial and ventricular

rates of 70 beats/minute, a PR interval of 0.24 seconds, and a QRS duration of

0.08 seconds. The nurse interprets this rhythm as:

1. normal sinus rhythm (NSR).

2. NSR with 1-degree atrioventricular (AV) block.

3. sinus arrhythmia.

4. accelerated junctional rhythm.

38. A client with abdominal aortic aneurysm asks the nurse in which area are

abdominal aortic aneurysms most commonly located. The best response by the

nurse is:
1. distal to the iliac arteries.

2. distal to the renal arteries.

3. adjacent to the aortic arch.

4. proximal to the renal arteries.

39. While palpating a client’s abdomen, the nurse notes a pulsating abdominal

mass. This may indicate which condition?

1. Abdominal aortic aneurysm

2. Enlarged spleen

3. Gastric distention

4. Gastritis

40. What is the most common symptom in a client with abdominal aortic

aneurysm?

1. Abdominal pain

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2. Diaphoresis

3. Headache

4. Upper back pain

41. A client is admitted to the step-down unit with an abdominal aortic

aneurysm. The nurse would be most concerned if the client experienced:

1. hypotension.

2. cramping in the legs.

3. sudden, severe back pain.

4. diaphoresis.

42. A client is scheduled for testing to diagnose an abdominal aortic

aneurysm. The most definitive test would be?

1. Abdominal X-ray

2. Aortogram

3. Computed tomography (CT) scan

4. Ultrasound

43. The nurse is caring for a preoperative client with an abdominal aortic

aneurysm. The client is most at risk for:

1. hypertension.

2. aneurysm rupture.

3. cardiac arrhythmias.

4. diminished pedal pulses.

44. A client with a myocardial infarction has received a thrombolytic agent.

What is the most important intervention by the nurse?

1. Avoid puncture wounds.

2. Monitor potassium levels.

3. Maintain a supine position.

4. Encourage fluids.

45. The nurse is assessing a client for an abdominal aortic aneurysm. Which

area does the nurse palpate?

1. Right upper quadrant

2. Directly over the umbilicus

3. Middle lower abdomen to the left of the midline

4. Middle lower abdomen to the right of the midline

45. 3. The aorta lies directly left of the umbilicus; therefore, any other region

is inappropriate for palpation.

CN: Physiological integrity; CNS: Basic care and comfort; CL: Application

46. Which condition is linked to more than 50% of clients with abdominal

aortic aneurysms?

1. Diabetes mellitus

2. Hypertension

3. Peripheral vascular disease

4. Syphilis

47. When auscultating the abdominal region of a client with abdominal aortic

aneurysm, the nurse hears a bruit. How does the nurse interpret this finding?

1. It is a normal finding.

2. It reflects a partial arterial occlusion.

3. It indicates a collection of fluid in the lungs.

4. It shows an inflammation of the peritoneal surface.

48. The nurse assesses a client with an abdominal aortic aneurysm and is most

concerned when the client presents with which of the following?

1. Lower back pain, increased blood pressure, decreased red blood cell

(RBC) count, and increased white blood cell (WBC) count

2. Severe lower back pain, decreased blood pressure, decreased RBC count,

increased WBC count

3. Severe lower back pain, decreased blood pressure, decreased RBC count,

decreased WBC count

4. Intermittent lower back pain, decreased blood pressure, decreased RBC

count, increased WBC count

49. During the assessment of a client who had an abdominal aortic repair, the

nurse notes a hematoma in the perineal area. The nurse interprets this as:

1. hernia.

2. stage 1 pressure ulcer.

3. retroperitoneal rupture at the repair site.

4. rapid expansion of the aneurysm.

50. A client who was recently diagnosed with an aneurysm asks the nurse if

any genetic disease is closely linked to an aneurysm. What is the best response

by the nurse?

1. Cystic fibrosis

2. Hemophilia

3. Marfan’s syndrome

4. Sickle cell anemia

51. A client’s aneurysm has ruptured. What is the priority intervention?

1. Antihypertensive medication administration

2. Aortogram
3. Beta-adrenergic blocker administration

4. Surgical intervention

52. A nurse is teaching a client about cardiomyopathy and determines further

teaching is needed when the client states:

1. “It is caused by a plaque in the arteries.”

2. “It is caused by a virus.”

3. “It is caused by bacteria.”

4. “It is caused by certain drugs.”

53. The nurse is counseling a client on types of cardiomyopathy associated

with childbirth. The nurse should teach the client about which of the

following?

1. Dilated

2. Hypertrophic obstructive

3. Myocarditis

4. Restrictive

54. The nurse is reviewing a client’s echocardiogram report, which states,

“hypertrophy of the ventricular septum.” The client should be further evaluated

for which type of cardiomyopathy?

1. Congestive

2. Dilated

3. Hypertrophic obstructive

4. Restrictive
55. A nurse is caring for a client with cardiomyopathy and is aware that the

client is at high risk for developing:

1. heart failure.

2. diabetes mellitus.

3. myocardial infarction (MI).

4. pericardial effusion.

56. While assessing a client with dilated cardiomyopathy, the nurse notices

that the electrocardiogram (ECG) rhythm no longer has any P waves, only a

fine wavy line. The ventricular rhythm is irregular with a QRS duration of 0.08

seconds. The heart rate is 110 beats/minute. The nurse interprets this rhythm

as:

1. atrial fibrillation.

2. ventricular fibrillation.

3. atrial flutter.

4. sinus tachycardia.

57. The nurse performs an assessment on a newly admitted client. The data

include dyspnea, cough, weight gain, weakness, and edema. The nurse

interprets these as signs and symptoms of:

1. pericarditis.

2. hypertension.

3. myocardial infarction (MI).

4. heart failure.
58. The nurse determines further teaching is necessary when a client with

cardiomyopathy states:

1. dilated cardiomyopathy decreases cardiac output.

2. cardiac output increases in hypertrophic obstructive cardiomyopathy.

3. cardiac output is not affected by hypertrophic obstructive cardiomyopathy.

4. restrictive cardiomyopathy decreases cardiac output.

59. The nurse is performing a cardiac assessment on her client and auscultates

a fourth heart sound (S4

). The nurse interprets this as indicative of which of the

following?

1. Dilated aorta

2. Normally functioning heart

3. Decreased myocardial contractility

4. Failure of the ventricle to eject all the blood during systole

60. Which class of drugs is most widely used in the treatment of cardiomyopathy?

1. Anticoagulants

2. Beta-adrenergic blockers

3. Calcium channel blockers

4. Nitrates

61. If medical treatment for cardiomyopathy fails, the nurse should prepare the
client for which of the following procedures?

1. Cardiac catheterization

2. Coronary artery bypass graft (CABG)

3. Heart transplantation

4. Intra-aortic balloon pump (IABP)

62. Which condition is associated with a predictable level of pain that occurs

as a result of physical or emotional stress?

1. Anxiety

2. Stable angina

3. Unstable angina

4. Variant angina

63. After undergoing a cardiac catheterization, a client has a large puddle of

blood under his buttocks. The most important intervention by the nurse is:

1. call for help.

2. obtain vital signs.

3. ask the client to “lift up.”

4. apply gloves and assess the groin site.

64. A client with angina pectoris has a stat electrocardiogram (ECG)

performed during an episode of chest pain. The nurse reviews the ECG and

notes myocardial ischemia. This would be displayed as:

1. increased QRS duration.

2. shortened PR interval.
3. pathological Q-wave formation.

4. T-wave inversion.

65. A client with an impending myocardial infarction (MI) is experiencing

angina. The nurse would document the angina as?

1. Variant angina

2. Chronic stable angina

3. Microvascular angina

4. Unstable angina

66. A client with angina pectoris comes to the emergency room. Which of the

following drugs can the nurse expect to administer?

1. Aspirin

2. Furosemide (Lasix)

3. Nitroglycerin

4. Nifedipine (Procardia)

67. While assessing a client diagnosed with angina, the client asks what

causes it. Which of the following responses by the nurse would be the most

appropriate?

1. Increased preload

2. Decreased afterload

3. Coronary artery spasm

4. Inadequate oxygen supply to the myocardium

68. A nurse is preparing a client for cardiac catheterization. What is the

priority assessment for the nurse to obtain?

1. Weight and height

2. Allergy to iodine or shellfish

3. Apical heart rate

4. Cardiac rhythm

69. The nurse is teaching a client about angina. Which statement by the nurse

would be most accurate regarding the primary treatment goal?

1. Reversal of ischemia

2. Reversal of infarction

3. Reduction of stress and anxiety

4. Reduction of associated risk factors